The cholesterol issue is at the heart of every dietary recommendation for the past 30 years, says Dr. Jonny Bowden. "When you think about it – and I have thought about it – it has influenced everything we have been taught about what to eat and what not to eat."
Together with Stephen Sinatra, M.D., a board certified cardiologist with more than 30 years of clinical practice, they wrote a new book, The Great Cholesterol Myth, which Fair Winds Press published on November 1. Alternatively, you can get a Kindle edition, which is what the publisher sent me for review.
Dr. Bowden has a Ph.D. in nutrition and is the author of 10 books with some of the soundest advice on what to eat that I have ever read. His book Living Low Carb is one of the very best books on the lifestyle that I follow and recommend. My only regret is that I failed to discover it when it came out, so I haven’t reviewed it. Dr. Bowden tells me, however, that a revised edition is in the works, and I will certainly review it as soon as I get my hands on it.
The myths about cholesterol bear directly on the concerns that many otherwise well-informed people have about living a low-carb lifestyle. In fact, almost everyone will benefit from reading Dr. Bowden’s new book, The Great Cholesterol Myth. That’s because belief in the myths that surround cholesterol is so widespread.
The basic cholesterol myths are the pervasive beliefs that cholesterol causes heart disease and predict heart attacks. In fact, "Cholesterol is an essential molecule without which there would be no life," the book says. It is "so important that virtually every cell in the body is capable of synthesizing it." Furthermore, "there is no correlation between cholesterol and heart attack."
Consequently, even when we eat foods like eggs and seafood, which are high in the so-called "lousy cholesterol" – low-density lipoprotein or LDL – our bodies just respond by making less of it internally. The cholesterol myths also include the mistaken belief that fat, particularly saturated fat, is dangerous. The fact is that it isn’t. The dangerous fats are the artificial transfats that manufacturers produce from partially hydrogenated oils.
The myth connecting cholesterol and fat is what has scared many people on the basis of poor science – or no science at all – for at least 30 years. The result of this myth has been our decline in nutrition and an increase in diabetes and obesity as we substituted unhealthy polyunsaturated oils and added sugars and processed carbs for healthy fats.
These interconnected myths that lead us to terrible nutrition are bad enough. But worse follows. When we combine the Standard American Diet with the standard American beliefs that high LDL cholesterol levels are bad and that popping pills are good, we get the statins.
Do we ever get them! About 32 million Americans take a statin. One-fourth of us 45 and over do. One of the statins, Lipitor, is the all-time biggest selling prescription medicine in the history of the world with sales of more than $130 billion.
We get the statins even though they can be extremely toxic and can even cause death. We don’t have any data showing that they will make us live longer. We believe that they can reduce the cholesterol levels of practically everyone, even though the evidence shows that few people besides middle-aged men who have already had a heart attack will benefit.
In spite of all the misinformation out there about cholesterol, diet, and the statins, we have actually come a long way. As recently as 1961 we didn’t have the technology to distinguish between "good" HDL and "bad" LDL cholesterol much less the newer technology that allows us to differentiate between different cholesterol subtypes and particle sizes. These alternative lipid tests include the Vertical Auto Profile test or VAP, Nuclear Magnetic Resonance or NMR, Lipoprotein Particle Profile or LPP, and the cholesterol test from Berkeley HeartLab.
For years I have been interested in and have written about these alternative lipid tests. Most doctors, however, don’t know anything about them. Even respected nutritionist Mark Sisson, who writes Mark’s Daily Apple, has concerns about them. A year ago he wrote that he didn’t think they were accurate enough. Since Dr. Bowden recommends that we use one or another of these alternative lipid tests, I asked him how he would respond to Mark’s evaluation.
"Mark’s probably right that the earlier versions of these tests were not perfect," Dr. Bowden told me. "But some of the problems he mentions-- like getting different results from two different labs-- are well known to happen with all kinds of blood measures, certainly not just this one.
"In any case, the tests these days are pretty darn good and, more importantly, even if they were 10% off they’re still providing the only information that means a thing in cholesterol testing, which is particle size and number. That makes them, in my book, a zillion times more valuable than the old-fashioned cholesterol test. I’d rather have a 95% accurate test that tests the right thing than a 100% accurate test that tests something that’s irrelevant."
Knowing that you have a "high" LDL level is pretty much a useless piece of information, Dr. Bowden says, unless you know how much of your LDL is the small, dense kind (which is harmful) and how much is the big, fluffy kind (which isn’t). And a much better way to predict heart disease is to calculate your ratio of triglycerides to HDL.
In one study published in Circulation, the journal of the American Heart Association, people with the highest triglyceride-to-HDL ratios had 16 times the risk of developing heart disease than those with the lowest ratios. "If you have a ratio of around 2, you should be happy, indeed, regardless of your cholesterol levels," while a ratio of 5, "is problematic."
One of the most pervasive myths we have is that a low-carb diet will lead to dangerously high lipid levels. Since I have been following a very low-carb diet since 2007, I looked up my ratio of triglycerides to HDL in my most recent lipid profile. I’m not very good at numbers, but I could see that this number was okay: my triglyceride level was 79 and my HDL was 73, so my ratio seems to be a quite acceptable 1.08. In June 2004, before I started a very low-carb diet, my triglyceride level had been 160 and my HDL was 27 – for a dangerously high ratio of 5.93.
This review necessarily focuses on the key myths and facts about cholesterol that stand at the root of the misguided nutrition policies of this country. The 240 pages of this most readable book cover much more, including the true cause of heart disease (inflammation) and what we can do to help our heart (certain supplements). If you are still a believer in any of these myths about cholesterol, please invest a little time and money. Buy and read this book.
David Mendosa was a journalist who learned in 1994 that he had type 2 diabetes, which he wrote about exclusively. He died in May 2017 after a short illness unrelated to diabetes. He wrote thousands of diabetes articles, two books about it, created one of the first diabetes websites, and published a monthly newsletter, “Diabetes Update.” His very low-carbohydrate diet, A1C level of 5.3, and BMI of 19.8 kept his diabetes in remission without any drugs until his death.